Skin lesions accompanying hematological malignancies can\ud be formed due to either direct tumor infiltration of the skin\ud or indirect effects. Indirectly developing lesions may be a\ud component of paraneoplastic syndrome. Erythema annulare\ud centrifugum (EAC) is considered to be a hypersensitivity\ud reaction developed against various antigens associated with\ud infections, drugs, and endocrine diseases. EAC, rarely seen in\ud neoplastic diseases, has been reported in lymphoma, leukemia,\ud histiocytosis, and prostate cancer. Here we report EAC in a\ud patient using a hypomethylating agent, azacitidine.\ud A 69-year-old female patient was admitted to our polyclinic\ud with weakness and ecchymosis in her legs existing for 3\ud months. She was considered as having refractory anemia with\ud excess blasts-2 according to myelodysplastic syndrome (MDS)\ud classification [1]. Because there was only hyperdiploidy in\ud conventional cytogenetic examination, she was classified in\ud group intermediate-2 of the International Prognostic Scoring\ud System. She had a history of radical mastectomy and adjuvant\ud chemoradiotherapy for breast cancer 3 years ago. She said that\ud variously sized round and oval erythematous, itching, painless\ud lesions had formed in the abdominal region on the 4th day of\ud azacitidine usage (75 mg/m2/day, 7 days, s.c.) (Figure 1 and 2).\ud There were no concomitant complaints or physical examination\ud findings except fatigue. After azacitidine was stopped, a skin\ud biopsy was taken. In the biopsy, mild perivascular inflammatory\ud infiltration accompanying vascular ectasia in the papillary dermis\ud was detected. The possibility of paraneoplastic syndrome was\ud excluded due to the disappearance of all lesions by 1 week after\ud cessation of treatment. During the second course of azacitidine,\ud the lesions reoccurred on the second day. Subsequently to the\ud second course, the patient died of sepsis, which developed after\ud pneumonia

Previous studies have shown that patients with polycythemia vera (PV) have poor quality of life (QoL). Similarly, it has been shown that survival is influenced by QoL. We aimed to evaluate QoL in 88 Turkish patients with PV. This cross-sectional study included cases diagnosed with PV between January 1995 and August 2019 who attended follow-up studies in the hematology department of a tertiary hospital in Türkiye between August 2019 and July 2020. Beginning in August 2019, subjects who approved study participation applied the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire during their routine follow-up–given that they met inclusion/exclusion criteria. Individuals with comorbidities or factors influencing QoL and those with secondary PV-related conditions were excluded. Recorded data included age, sex, history of bleeding, thrombosis, erythrocytosis, leukocytosis, thrombocytosis, obesity or splenomegaly, and cytogenetic mutation profiles such as JAK2, BCR and MPL. We also assessed whether they needed phlebotomy or erythrocyte suspensions. Data concerning comorbidities and medication use were obtained from medical records. The median age of patients was 52 (44–61) years. The majority of participants were male (67.05%). Global health status score was 75 (66.67–83.33). PV patients who had required phlebotomy demonstrated higher social functioning scores (P = .004) and lower scores for loss of appetite (P = .013) and financial difficulties (P = .020) than patients without phlebotomy. PV patients who had suffered from leukocytosis demonstrated lower physical functioning scores compared to those without leukocytosis (P = .001). Patients without JAK2 exon 14 mutations had better physical (P = .016) and cognitive functioning scores (P = .048). It was found that PV patients with splenomegaly demonstrated lower physical functioning (P = .019) and higher appetite loss scores (P = .005) than those without splenomegaly. Higher leucocyte counts were associated with decreased physical functioning and greater fatigue. In conclusion, we demonstrated deterioration of physical and emotional QoL in patients diagnosed with PV. Patients with PV require individualized, patient-specific and integrated approaches in order to minimize symptoms, improve QoL, and increase survival.

Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by isolated thrombocytopenia. While first-line treatments focus on inhibiting autoantibodies and platelet destruction, second- and third-line treatments include splenectomy and Thrombopoietin receptor agonists (TPO-RAs). In this study, we aimed to compare the efficiency and toxicities of splenectomy and Eltrombopag as second-line treatments in ITP. We retrospectively analyzed patients who were diagnosed with ITP and followed between 2015 and 2020. Patients who underwent splenectomy or received Eltrombopag treatment as 2nd or further line therapy were included. For subgroup analyses, patients were further stratified according to whether they received Eltrombopag in the second or third line of treatment. There were 38 patients in the splenectomy group and 47 patients in the Eltrombopag group. Mean age of patients in splenectomy and Eltrombopag groups 43.2 and 50.5, respectively. Time to response is significantly shorter in the splenectomy arm (p= 0.001). However, response rates at the 3rd, 6th, 12th, and 24th months, total duration of response and adverse events did not exhibit a statistically significant difference between groups. Response rates at the 1st, 3rd, 6th, 12th, and 24th months and the total duration of response did not exhibit a statistically significant difference between the Eltrombopag subgroups. Eltrombopag treatment was ceased in 20 patients after a median of 54.1 months (1-151). Among them, 12 patients (60%) did not experience a loss of response. When we compare the splenectomy and eltrombopag arms, even though time to achieving response is in favor of splenectomy, this advantage disappears when overall response rates and response rate at the 2nd year are considered. Using eltrombopag in the 2nd or 3rd line of therapy does not yield any difference in terms of time to achieving response.

Thrombosis is a leading cause of morbidity and mortality in paroxysmal nocturnal hemoglobinuria (PNH). Multiple factors are responsible for the thrombotic tendency in these patients. Endothelial progenitorcells (EPCs) originate from primitive hematopoietic stem cells. The EPC count is considered indicative of potential damage and restoration capacity in vascular disease; lower EPC counts are deemed as a risk factor in cardiovascular diseases. We aimed to investigate the count of circulating EPCs in PNH and aplastic anemia (AA) patients receiving eculizumab treatment or not receiving treatment and their relationship with thrombosis. Seventeen PNH patients, 18 AA patients, and 10 healthy volunteers were included in the study. The CD309, CD133, and CD34 antibodies were used to determine counts of circulating EPCs using flowcytometry. EPC levels were compared between the PNH, AA, and healthy control groups. Kolmogorov–Smirnov test. ANOVA, Kruskal–Wallis, and Mann–Whitney U testswereperformedto analyze the quantitative data, while χ2 testing was performed to analyze the qualitative data. Therewasnosignificantdifference in EPC levelsbetweenpatientswithandwithout a history of thrombosis (P > 0.05). Further, therewasnosignificantdifference in thelevels of EPCsbetweenthe AA and PNH groups (P  > 0.05). However, there was a significant positive correlation between levels of EPCs and lactate dehydrogenase (LDH) in multivariate analysis (P < 0.05). The study findings suggest that hemolysis promotes vascular endothelial and new blood vessel formation. Increased EPCs in PNH may indirectly indicatevascular endothelial damage in PNH.